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OPP > Shoulder Mechanics and Counterstrain > Flashcards

Shoulder Mechanics and Counterstrain Flashcards

1
Q

What 4 joints make up the shoulder joint?

A

Scapulothoracic articulation
glenohumeral hoint
acromioclavicular joint
sternoclavicular joint

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2
Q

What are the 6 major motions of the shoulder joint?

A 
Flexion
Extension
Abduction
Adduction
External rotation
Internal rotation
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3
Q

What is the glenohumeral joint ‘designed’ for?

A

Maximum motion at the expense of decreased stability. Minimal osseous support.

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4
Q

Where do the first 30 degrees of shoulder abduction occur?

A

At the glenohumeral joint

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5
Q

What is scapulothoracic rhythm?

A

First 30 degrees of shoulder articulation occurs at the glenohumeral joint

After that, for every 2 degrees of motion at the the glenohumeral joint there is 1 degree of motion at scapulothoracic joint

Sometimes there’s a 3:2 ratio

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6
Q

What can happen if the scapulothoracic articulation is restricted? What dysfunctions are frequently associated with the scapulothoracic articulation?

A

Glenohumeral joint may have compensate with increased motion.

Frequently associated with thoracic spine and rib dysfunction

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7
Q

What 4 things can a restricted scapulothoracic joint predispose someone to?

A

A compensated glenohumeral joint (increased motion):

  1. instability
  2. impingement
  3. rotator cuff tendonitis
  4. tears
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8
Q

What does somatic dysfunction of the scapulothoracic articulation contribute to?

A

Imbalance in the muscles affecting scapular motion and scapular stability

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9
Q

What is another small joint that moves in response to scapular motion?

A

Sternoclavicular joint

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10
Q

What are the motions of the sternoclavicular joint?

A

Anteroposterior
Superoinferior
Rotational motion

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11
Q

How can the sternoclavicular joint become restricted from a distal structure?

A

Restriction from shoulder injury

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12
Q

Why is posterior dislocation of the sternoclavicular joint be bad?

A

Compromises important neurovascular structures

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13
Q

What is a frequent mode of injury for the acromioclavicular joint?

A

Becomes separated when someone lands or is hit on the point of the shoulder

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14
Q

How does the acromioclavicular joint become restricted?

A

Usually with shoulder injury

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15
Q

What are the motions of the acromioclavicular joint?

A

Anteroposterior
Superoinferior
Rotational motion

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16
Q

In a general sense, what innervates the upper extremities?

A

Brachial plexus

C5-T1

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17
Q

What is the course of the brachial plexus?

A

Between anterior and middle scalenes
Between the first rib and clavicle
Underneath the pectoralis minor muscle

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18
Q

What SDs can have a negative impact on the brachial plexus and upper extremity functions?

A 
SDs affecting the:
cervical spine
upper thoracic spine
upper ribs
scalene muscles
clavicle 
pectoralis minor
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19
Q

What innervates the glenohumeral muscles?

A

Brachial plexus

C5-T1

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20
Q

What are the primary flexors of the glenohumeral joint?

A

Pectoralis major
Anterior deltoid
coracobrachialis

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21
Q

What are the primary extensors of the glenohumeral joint?

A

Latissimus dorsi
Teres major
Posterior deltoid
Long head of triceps brachii

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22
Q

What are the primary abductors of the glenohumeral joint?

A

Deltoids

Supraspinatus

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23
Q

What are the primary adductors of the glenohumeral joint?

A

Pectoralis major
Latissimus dorsi
Teres major
Long head of triceps brachii

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24
Q

What are the primary external rotators of the glenohumeral joint?

A

Infraspinatus
Teres minor
Deltoid muscle

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25
Q

What are the primary internal rotators of the glenohumeral joint?

A 
Subscapularis
Pectoralis major
Latissimus dorsi
Deltoids
Teres major
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26
Q

What is the innervation of pectoralis major?

A

C5-T1

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27
Q

What is the innervation of the deltoids?

A

Axillary nerve

C5 and C6

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28
Q

What is the innervation of coracobrachialis?

A

Musculocutaneous nerve

C5, C6, C7

29
Q

What is the innervation for latissimus dorsi?

A

Thoracodorsal nerve

C6, C7, C8

30
Q

What is the innervation for teres major?

A

Lower subscapular nerve

C5 and C6

31
Q

What is the innervation for triceps brachii?

A

Radial nerve

C6 C7 C8

32
Q

What is the innervation for supraspinatus?

A

Suprascapular nerve

C4, C5, C6

33
Q

What is the innervation for infraspinatus?

A

Suprascapular nerve

C5, C6

34
Q

What is the innervation for teres minor?

A

Axillary nerve

C5 and C6

35
Q

What is the innervation for subscapularis?

A

Upper and lower subscapular nerves

C5, C6, C7

36
Q

How can SD affect the function of muscles?

A

Can affect their nerve roots, and all mm ‘downstream’ of that nerve root will be affected
- often produces weakness

37
Q

What are the 4 rotator cuff muscles?

A

Supraspinatus
Infraspinatus
Teres minor
Subscapularis

38
Q

What do the rotator cuff muscles do?

A

Work together to keep the head of the humerus centered in the glenoid fossa

Analogous to a seal balancing a ball on its nose

39
Q

What happens if a rotator cuff muscle is out of balance?

A

Glenohumeral joint is less stable and more prone to injury

Can also happen if scapulothoracic rhythm is off

40
Q

What is the arterial supply for the upper extremities?

A

Left and right subclavian arteries

41
Q

What is the course for the arterial supply for the upper extremities?

A

Subclavian arteries pass over the top of the first rib between the anterior and middle scalene mm

42
Q

What can affect upper extremity arterial supply?

A 
SD of:
anterior and middle scalenes
upper thoracic vertebrae
cervical vertebrae
upper ribs
clavicles
fascia of the neck
fascia of upper extremity
43
Q

What is the venous drainage of the upper extremities? What is their passage?

A

Subclavian and brachiocephalic veins

Pass anterior to scalenes

44
Q

How does SD affect the veins of the upper extremity?

A

SD along the course can lead to swelling and congestion due to poor drainage.

Swelling affects proprioception and slows down rehab

45
Q

What is the lymphatic drainage of the upper extremities?

A

Through the thoracic inlet, ultimately

46
Q

What SD affects lymph drainage of the upper extremities?

A

SD affecting thoracic inlet

  • produces a mechanical restriction to lymph flow
  • produces congestion in upper extremities
  • reduces healing
  • negatively affects rehabilitation
47
Q

Where are the preganglionic sympathetic cell bodies for the upper extremities?

A

In T2-T6, in upper thoracic spinal segments

48
Q

What happens to the smooth muscles when they receive sym inn?

A

Smooth mm in lymph vessels contract

  • impedes lymph return,, reduced lumen size
  • causes congestion
49
Q

How does upper thoracic SD affect the upper extremities?

A

Increases sym tone
Decreased lymph drainage
- can lead to increased swelling
- impairs function and recovery

50
Q

Where is force transmitted during throwing?

A

Force is transmitted from the ground

  • through the lower extremity
  • through spine
  • through shoulder
  • through entire upper extremity

Requires integration of all of these structures, if 1 breaks then all are at risk, esp the shoulder.

51
Q

During overhand throw, what percentage of kinetic energy is generated by legs and trunk?

A

50% - half from ground, half from shoulder

52
Q

What is needed for optimal rotator cuff function?

A

Stable scapula

53
Q

What is scapular retraction during throwing stimulated by?

A

Ipsilateral hip and trunk extension

54
Q

What does ipsilateral mean?

A

Same side

55
Q

What else is necessary for throwing?

A

Engagement of the gluteal mm to stabilize pelvis

- contributes to scapular stabilization and control

56
Q

What stabilizes the scapula during throwing?

A

Engagement of the gluteal mm to stabilize pelvis
- contributes to scapular stabilization and control

Lower trapezius
lower rhomboids
serratus anterior

57
Q

What can destabilize the scapula during throwing?

A

Weak gluteals
Altered mm firing patterns - from SD

Psoas major mm tension

  • alters hip extension
  • freq involved with shoulder/rotator cuff injury
58
Q

What is the braking mechanism of throwing?

A

MM fire to stop the large angular velocity that throwing creates at the glenohumeral joint

59
Q

What mm are responsible for the braking mechanism of the shoulder, i.e. for throwing?

A

Posterior shoulder mm

  • posterior deltoid
  • teres minor
60
Q

What are some common areas of dysfunction associated with the shoulder?

A 
Sacrum
innominates
lumbar spine
latissimus dorsi - tightness reduces shoulder flexion
thoracolumbar region
61
Q

Where do you find SD in the thoracolumbar region?

A

T10-T12

62
Q

What is SD of the thoracolumbar region associated with?

A

Altered function of the thoracolumbar fascia
latissimus dorsi mm
psoas major mm
diaphragm

63
Q

What is a reflex pattern you see with shoulder dysfunction?

A

Reflex pattern involving the adrenal glands

  • somatovisceral or viscerosomatic, T6-L2
  • assoc. with adrenal fatigue in overtrained athletes
64
Q

What changes happen with bad posture?

A

Increased kyphosis - sitting slumped forward

  • protracts the scapula
  • Pec minor and biceps mm tighten
  • hamstrings and psoas major mm tighten

Alters scapular function and position

65
Q

What is the net result of bad posture?

A

Rotator cuff imbalance

  • greater predisposition to injury
  • superior migration of humeral head = impingement on rotator cuff
66
Q

How do you treat shoulder problems?

A

Combine OMM with ROM and strengthening exercises

- treat whole patient, look out for systemic disease

67
Q

What is procedure for counterstrain?

A
  1. Locate a tender point
  2. Establish a pain scale
  3. Find a position that reduces the discomfort to 3/10 at least
  4. Hold position for at least 90 seconds
  5. Slowly return patient to starting position
  6. Reasses
68
Q

What if the patient fails to respond to conservative treatment or has progressive neurological symptoms?

A

Consider referral for further evaluation, maybe surgery.

OPP (5 decks)

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